Provider Demographics
NPI:1821773821
Name:PHILLIPS, MARLENE (NBCHWC)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NBCHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2576 60TH LN
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:CO
Mailing Address - Zip Code:81025-9715
Mailing Address - Country:US
Mailing Address - Phone:719-251-1656
Mailing Address - Fax:
Practice Address - Street 1:2576 60TH LN
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:CO
Practice Address - Zip Code:81025-9715
Practice Address - Country:US
Practice Address - Phone:719-253-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach